Individual provider Active NPI

Chelsea Leigh Kohlbeck, APNP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1396464434
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
12125-33 Issued in WI
Practice address
3925 N Gateway Dr
Appleton, WI 54913-7863
Phone
(920) 427-8111
NPI assigned
Aug 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 12125-33 WI Primary

Addresses

Primary practice location

3925 N Gateway Dr
Appleton, WI 54913-7863

Mailing address

3925 N Gateway Dr
Appleton, WI 54913-7863
Phone (920) 830-6877

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL thedacare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928001312 WI Practitioner - Nurse Practitioner 8325424302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

3925 N Gateway Dr
Appleton, WI 54913-7863
Phone (920) 454-8401

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12125-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Sep 20, 2022 Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3925 N Gateway Dr
Appleton, WI 54913
Phone (920) 702-6371

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

333 N Green Bay Rd
Neenah, WI 54956
Phone (920) 725-2070

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: ckohlbeck326286@direct.thedacare.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1396464434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 N GATEWAY DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137863",
            "telephone_number": "920-830-6877",
            "fax_number": "920-993-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 N GATEWAY DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137863",
            "telephone_number": "920-427-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHLBECK",
        "first_name": "CHELSEA",
        "middle_name": "LEIGH",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "12125-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "thedacare.org",
            "affiliation": "N",
            "address_1": "3925 N Gateway Dr",
            "city": "Appleton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549137863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.